Monthly Archives: August 2013

Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.

About 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are significant variations in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.

Obstetricians in many medical settings are paid more for C-sections. In a new working paper published by the National Bureau of Economic Research, health care economists Erin Johnson and M. Marit Rehavi calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more. Continue reading →

With an inmate hunger strike over conditions at California’s highest security lockups now at day 54, it seems remarkable that none of the 41 prisoners refusing food since July 8 has experienced serious or life-threatening medical problems.

Officials monitoring the protest report that, as of Wednesday, the men had body mass indexes in the 20s, well above a danger zone established by the court-appointed receiver overseeing prison medical care. Only two of the prisoners had lost more than 15 percent of their body weight, another critical measure.

While the inmates are clearly suffering as a result of the extended fast, and report bouts of extreme nausea and dizziness, there are “no imminent health emergencies and no prisoners in critical condition,” said Joyce Hayhoe, a spokesperson for receiver Clark Kelso.

So what’s keeping the hunger strikers from more severe starvation? The answer, it turns out, could be mass quantities of Gatorade, the ubiquitous sports drink.

Under state rules, inmates are considered on hunger strike if they refuse all state meals for more than three days and have no other food items in their cells, such as snacks from the prison commissary. Continue reading →

That’s right, we won’t see movie stars or rock stars. Instead, we see signs. Yes, signs. That’s what the ad is titled: “signs.”

To be fair, Lee completed his “you won’t be seeing rock stars” thought with “you’ll be seeing real people.” But mostly we see signs at the beginning of the ad. There’s a lot of somewhat wonky voiceover about “equal access to quality health insurance,” “financial assistance” and “pre-existing conditions.” We heard none of those things in the Cover Oregon ads — instead the ads left me with a wonderful feeling about how great Oregon is — and therefore how great Cover Oregon must be. Cover Oregon seemed to embrace the concept of branding. Is it too late to call in Don Draper of “Mad Men”? Or maybe Peggy Olson?

But not everyone is reacting the way I am. Larry Levitt, senior vice president at the Kaiser Family Foundation, said in an email that he appreciated that “these ads emphasized actual protections and the subsidies, in contrast, for example, to the Vermont ads that don’t really mention anything.” Like Oregon, Vermont also took a more generic approach. Anthony Wright of Health Access liked the ads, too. “You can have the beautiful textures of the California coast and Central Valley, while also providing concrete information consumers need,” he said.

Students eat lunch in the Oakland High School cafeteria. To get lunch, students in one line enter their ID numbers – used by staff to track free and reduced-price meals – and then receive tickets to exchange for meals in other lines. One student said he typically waits 20 to 25 minutes for food. (Noah Berger/Center for Investigative Reporting)

The green beans are portioned and displayed in orderly rows. The lasagnas are steaming up their plastic covers. The workers stand ready, their hair netted and aprons tied. The bell rings, and a stream of nearly 1,000 students floods in to Francisco Bravo Medical Magnet High School’s cafeteria, barely slowing as they load cardboard trays with apple juice, chicken wings and sliced cucumbers.

Hungry students are more prone to headaches, stomachaches and behavior problems and less able to concentrate in class, educators say.

Because lunch is free for all students at Bravo, in the Boyle Heights neighborhood of Los Angeles, no one pauses to pay. Still, during the lunch rush this day in May, food service worker Rodelinda Gomez stops a few.

“Hey! Hey!” Gomez hollers to students with no greens on their trays. “Come on and get your vegetables. You have to get them!”

For schools to receive federal reimbursement for lunches, they must serve — not just offer — each student at least a half-cup of fruit or vegetables. Lunches also must include servings of at least two other foods, such as a protein and a grain.

The requirement, adopted in the last school year, is part of an effort to serve students healthier foods. And eating those foods takes time – more time than many students have.

“A student can eat a cup of applesauce in no time – you can practically drink that. But chewing through an apple takes a lot longer,” said Diane Pratt-Heavner, spokeswoman for the School Nutrition Association, a national advocacy organization. “If we want our students to eat more salads, fruits and vegetables, we need to give them more time to consume them.” Continue reading →

Here in the U.S. pregnant women focus, sometimes obsessively, on diet, nutrition and prenatal vitamins — and debate about use of epidurals or C-section rates. But in the developing world, getting just the most basic information to pregnant women and new mothers has been a monumental task, and that lack of information contributes to high mortality rates.

Every day about 800 women in the developing world die during pregnancy or childbirth and more than 3 million newborns die of preventable illnesses every year, Kristen Gagnaire told me recently. She was in San Francisco spreading the word about MAMA, the Mobile Alliance for Maternal Action. Gagnaire is MAMA’s global director and a firm believer in the power of education to make a difference. She’s working to get information out to help save lives via a surprisingly simple platform: the mobile phone.

“The fetus develops in the same way in a mother, whether she’s in Zambia or she’s in California or she’s in the UK.”

MAMA is a global public-private partnership launched two years ago by former Secretary of State Hillary Clinton. USAID, Johnson & Johnson and the U.N. Foundation are all involved. And so is San Francisco’s BabyCenter (a division of Johnson & Johnson) where we met, along with Colleen Hancock, BabyCenter’s global chief operating officer. On its website BabyCenter says one its main areas is to provide “expert advice” about pregnancy, childbirth, babies, toddlers and more. It is a trusted source for women in the U.S. and other western countries. Continue reading →

Just as kids are heading back to classrooms, a new state audit has found that most schools do not track whether their anti-bullying programs have made campuses any safer and that schools are inconsistent in how they record and resolve bullying incidents.

The California Department of Education has been insufficient in both oversight and guidance, the audit said. It further noted that the department went four years without noticing that it was not monitoring schools to ensure they were addressing student complaints, as required by law. At the same time, funding has been cut for statewide surveys on student safety, making it more difficult to determine students’ experiences with bullying.

“The audit shows that passing laws isn’t enough. We need to implement them and ensure accountability at the district, county and statewide levels.”

On the plus side, the audit did find that the vast majority of California schools have anti-bullying programs in place and have provided staff training in how to prevent bullying, discrimination, harassment and intimidation.

Still, one advocate said the audit confirms that much remains to be done to reduce the high levels of bullying in California schools.

“The audit shows that passing laws isn’t enough –- we need to implement them and ensure accountability at the district, county and statewide levels,” said Jesse Melgar, with Equality California, a San Francisco-based advocacy group. “Now, California schools and the Department of Education have an opportunity to use the audit’s findings to review, update and enhance their policies to better protect our youth and ensure student success.” Continue reading →

Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)

Take a hard look at the picture. These are images we don’t see in this country at all anymore. But until the polio vaccine came along in 1955, children and adults paralyzed from polio were fairly commonplace. (FDR, anyone?) Today, vaccines are now a victim of their own success. Because they’ve so successfully wiped out devastating childhood illnesses, people seem not to fear those illnesses anymore. Now we have parents who decide not to have their children vaccinated.

As KQED News has reported this week, the number of parents in Marin County opting out of vaccines for their children is climbing. Last year, 7.8 percent of Marin parents opted out, 1 percentage point higher than the previous year. At present, California has one of the most lenient laws in the country to allow parents to decline vaccinating their kids: the “personal belief exemption.” It’s a short statement that says vaccinations are against a parent’s beliefs. (A new law amends this exemption somewhat; more on that below.)

On Thursday, KQED’s Forum took up the question of vaccines, and it was clear that many people remain confused on some key points.

Kaiser Permanente wants to know what’s lurking in their hospitals’ mattresses. Mattresses are often treated with brominated flame retardants. And these chemicals usually don’t stay put. They leak into the air or cling to specks of dust and enter our bodies.

“Flame retardants can be quite toxic. They accumulate in the environment and in our fat cells,” said Kathy Gerwig, vice president and environmental stewardship officer at Kaiser.

Certain beds may contain vinyl or other plastics that when produced or destroyed can release toxins into the environment.

The Environmental Protection Agency is currently reviewing the safety of these chemicals, which have been linked to increased cancer risk and other health issues.

Gerwig’s team is trying to figure out what’s in their stock. If they prove to be harmful, swapping out hospital beds is bound to be a big undertaking. “We have a lot of mattress,” she said. But if necessary, it’s a task Gerwig would embrace.

Kaiser hospitals are among more than 100 private and public hospitals in California that are moving toward more sustainable practices for their facilities, said Laura Wenger, executive director of Practice Greenhealth. Continue reading →

Farmworkers in the fields near Modesto, CA. Experts estimate that meeting the requirements of the Affordable Care Act’s minimum health plan requirement will cost about $1 per hour per employee in the field. (Sandy Huffaker/Getty Images)

Farm labor contractors across California — the nation’s biggest agricultural engine — are anxiously studying a provision of the Affordable Care Act, which will require hundreds of thousands of field workers to be covered by health insurance.

Insurance brokers and health providers estimate that meeting the Affordable Care Act’s minimum health plan will cost about $1 per hour per employee in the field.

And while the requirement to cover workers was recently delayed until 2015, the contractors, who provide farmers with armies of field workers, say they are already preparing for the potential cost, inconvenience, and liability the new law will bring to their business, which typically operates on a slender profit margin.

“I’ve been to at least a dozen seminars on the Affordable Care Act since February,” said Chuck Herrin, owner of Sunrise Farm Labor, a contractor based here. “If you don’t take the right approach, you’re wiped out.” Continue reading →

About State of Health

California faces health care challenges seen across the country: soaring costs, increasing chronic illness and a high rate of uninsured. At a time of intense focus on reform, "State of Health" explores these issues and more, bringing you stories of challenge and change in the Golden State. The blog is edited by Lisa Aliferis.